Effect of COVID‐19 on healthcare workers' morbidity and mortality compared to the general population in Kohgiluyeh and Boyer‐Ahmad Province, Iran

Abstract During the Covid‐19 pandemic, the adverse effects of recent coronaviruses on healthcare professionals cannot be ignored. This study compared the admission rates due to Covid‐19 and characteristics of hospitalized healthcare workers with the general population of Kohgiluyeh and Boyer‐Ahmad (K.B) province. 18546 hospitalized patients infected with Covid‐19 in hospitals in four cities of K.B province were enrolled in this study; of them, 236 (1.27%) patients were healthcare workers. Demographic and clinical data of hospitalized cases due to Covid‐19 infection were collected from August 2020 to September 2021. The underlying diseases were also considered in this study. According to our findings, 55.5% of the hospitalized healthcare workers were male, and 44.5% were female; their mean age was 41.41 years. However, in the general population, hospitalization rates were higher for women than for men (51.2% and 48.8%, respectively). Although the SARS‐CoV‐2 infectivity rate was higher in healthcare workers compared to the general population (68.6% vs. 56.1%), the mortality rate was significantly lower in them (1.7% vs. 3.8%). Fever, cough, Acute Respiratory Distress Syndrome, headache, and myalgia were the most prevalent symptoms in both groups. Among the cases examined in this study, inpatient ones aged 30–40 years and the general population aged over 60 seemed to be more likely to be hospitalized for Covid‐19. The hospitalization rate of healthcare workers during the pandemic follows the same pattern as the general population, but since the start of vaccination, this rate has decreased among healthcare workers compared to the general population of KB province.


| INTRODUCTION
In late December 2019, local hospitals in Wuhan discovered the culprit, a novel coronavirus (SARS-CoV-2), using a surveillance method for "pneumonia of unknown etiology" that was built in the aftermath of the 2003 Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) outbreak with the goal of allowing early detection of novel infections.
The World Health Organization (WHO) announced Covid-19 a "public health emergency of worldwide significance" on January 30, 2020. [1][2][3][4][5] In general, coronaviruses are genetically categorized into four primary genera, namely Alpha, Beta, Gamma, and Delta. They mostly cause respiratory and gastrointestinal tract diseases. The first two genera primarily infect the mammals, while the third and fourth genera largely infect the birds. Up to now, six types of human coronavirus have been discovered. The Alpha coronavirus genus includes HCoV-NL63 and HCoV229E, while the Beta genus includes HCoVHKU1, HCoV-OC43, Middle East Respiratory Syndrome Coronavirus (MERS-CoV), and SARS-CoV. Coronaviruses were not well-known until the 2003 SARS pandemic, which was followed by the 2012 MERS outbreak and, most recently, the Covid-19 outbreak. [6][7][8][9] SARS-CoV-2 has a single-stranded RNA genome that is roughly 30 kb in size and is similar to others. Both structural and nonstructural proteins are encoded in the RNA. Spike glycoprotein (S is comprised of two domains, namely S1 and S2), an envelope protein (E), a membrane protein (M), and a nucleocapsid protein (N) are structural proteins which are all located towards the third end of the strand. 10 SARS-CoV-2 mostly affects the respiratory system and, like other respiratory infections, spreads primarily through respiratory droplets thrown via sneezing and coughing. Fever, cough, exhaustion, and shortness of breath are the most common postinfection symptoms. Additionally, some patients lose their ability to taste and smell. However, additional symptoms such as headache, dizziness, and gastrointestinal symptoms (such as nausea, vomiting, and diarrhea) common. [11][12][13][14][15][16] Healthcare workers (HCWs) are a particularly vulnerable group for infection due to their frequent and close contact with  patients. Thus, it is critical to adhere to stringent hygiene standards to avoid patient-to-staff transmission. [17][18][19][20]

| Statistical analysis
Descriptive statistics were employed to categorize the research groups based on SARS-COV-2 PCR results. The categorized variables are reported using numbers and percentages. The χ 2 test was employed to determine statistically significant differences between categorical variables, and p < 0.05 was considered statistically significant. All data analyses were carried out using the SPSS software, version 26.

| RESULTS
This study was done on 18546 patients, of whom 236 (1.27%) were HCWs. Among the HCWs, 20 (8.5%) were physicians (residents and assistants), 116 (49.2%) were nurses, and 100 (42.4%) had other positions in the healthcare system. The hospitalized HCWs worked in seven hospitals of four main cities of this province. During the research period, there were three peaks in hospitalization rate amongst the patients. The highest incidence of SARS-CoV-2 infection in the HCWs group was at the first peak with a frequency of 27.6%.
Due to more direct exposure to infection, the peak of infection with Covid-19 occurred earlier in the HCWs than in general population. In the following months, the HCWs' hospitalization rate decreased until the 10th and 13th month when we witnessed an increase again, resulting in the formation of the second and third peaks of hospitalization. (Figure 1). The peak pattern of hospitalization rates for the general population was different from those of the healthcare workers, with the last peak being the highest. The most common age group in this study was 30-40 years for HCWs (40.3%) and >60 for general population (29.6%) ( Figure 2).
The most common symptoms reported by the hospitalized HCWs and general population were cough, myalgia, Acute Respiratory Distress Syndrome (ARDS), fever, and headache ( Table 2).
As shown in Figure 1, the overall morbidity rate among HCWs and the general population was 68.6% and 56.1%, respectively, and the mortality rate was 1.7% (4/236) and 3.8% (697/18310), respectively. It should be noted that the greater number of deaths in both groups is related to the first, second, and finally third pandemic peaks, respectively ( Table 3). writingreview and editing.

ACKNOWLEDGMENTS
The study was financially supported by Professor Alborzi Clinical

Microbiology Research Center of Shiraz University of Medical
Sciences. Our gratitude goes to Dr. Hassan Khajehei for the linguistic editing of the manuscript.